Fraser, H.

Godber, C.

Melia, D.

Townend, M.

Weizel, G.

Wimpenny, Katherine

Wood, A.

Coventry University Pure Portal

 Coventry University    Coventry University Repository for the Virtual Environment (CURVE)  Author name:  Wimpenny, K. , Townend, M. , Godber, C. , Fraser, H. , Wood, A. , Weizel, G. and Melia, D.    Title:  Practice development: integrating theory to enhance role identity for occupational therapists  Article & version: Presented version (powerpoint slides).   Original citation:  Wimpenny, K. , Townend, M. , Godber, C. , Fraser, H. , Wood, A. , Weizel, G. and Melia, D. (2010, June).  Practice development: integrating theory to enhance role identity for occupational therapists. Paper presented at the College of Occupational Therapists 34th Annual Conference, Brighton.  Further details: The abstract for this paper has been published in The British Journal of Occupational Therapy Volume 73, Supplement 1, 2010. The journal is available at http://www.ingentaconnect.com/content/cot/bjot/2010/00000073/a00108s1 (currently unavailable from this repository).  Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.   Available in the CURVE Research Collection: May 2011   http://curve.coventry.ac.uk/open  Practice development: Implementing professional theory to enhance role identity for occupational therapistsPresenters: Jo Hobbs, Marina Townend and Dr Katherine WimpennyAuthors: Heather Fraser, Jo Hobbs, Marina Townend (and all the occupational therapists) and Dr Katherine WimpennySetting the Scene• Worcestershire Mental Health NHS Partnership Trust Occupational Therapy Service• A two year plan to explore the contribution of professional theory• A  supported practice development initiative involving colleagues working across education and practice (Recovering Ordinary Lives, COT 2006)Setting the Scene - Practice Context• Contemporary practice is fluid and challenging (Higgs et al 2004)• Practitioners must articulate their specific contribution and make explicit their professional knowledge (Richardson et al 2004, Pettican & Bryant 2007)• Otherwise they will have it defined for them by their role set (Hughes 2001)Setting the scene: Policy Context 10 Essential Shared capabilities (DH 2004) Mental Capacity Act (2005)  ROL (COT 2006) New Ways of Working (2007) Mental Health Act (2007) New Horizons: a shared vision for mental health (2009)Not just about survival but how to flourish?The Role of Professional Theory• How do you know you are a competent practitioner? (Richardson et al 2004) • Making well informed decisions and demonstrating our worth is at the heart of occupational therapy practice (Melton et al 2008)• Professional theory enables us to review and critically examine our practice perspectives and anchor ourselves within professional domains (Forsyth et al 2005)So where do you start?Where do you start?• Invited a colleague from Coventry University to Trust OT Working Group• Explored and accessed funding • Service wide study day • Supported implementation processWhy MOHO? • Recognised conceptual model of practice• Body of research, which continues to evolve• ‘Scholarship of practice’ philosophy (Hammel et al 2002)• A wide range of tools and resourcesVolitionHabituationPerformance capacityPersonal causationValuesInterestsRolesRoutinesObjective and subjectiveskillparticipationocc. competenceocc. identityPerformanceEnvironmentPhysical & socialMOHO framework (adaptedKielhofner 2008:108 fig 8.4 )So where do you start?How are we doing it?• MOHO resources in Trust library• Monthly group supervision• Individual goal setting• Using MOHO throughout OT care pathways• Gradual introduction of a range of MOHO tools• Focus group with line managers and team leads• Focus groups and working party established with services users• Training for support worker staff to implement a selection of MOHO tools• Support for Band 5 therapistsWho else did we involve?Methods (used to gather interim findings for this presentation)• A working party of occupational therapists brought together • Questionnaires emailed to all qualified occupational therapists• 25 occupational therapists responded• Responses to questions analysed and themes generated• Contextualised in light of literatureInterim findings: Issues of time“our current service demands make it difficult to put time aside to try and introduce changes to practise”“the main setback is the time it takes to do something for the first time; having to allow yourself extra time to try something new where it is easier and quicker to do what you have always done”Interim findings: Resources“Paperwork has been a major hindrance. We have all the information in the library but are unable to take it away. We are 6 months in and have hardly anything scanned onto the shared drive…it would have been helpful to have had this at the start”Interim findings: Tensions“I sometimes feel these tools are only about increasing the OT profile and understanding, and can actually be a barrier to the therapeutic relationship”“it has been difficult to motivate to change from using the Canadian Model and to invest time and effort into this”Interim findings: Role constraints“what makes it difficult is the other elements of the job, projects on the ward, changes to Trust procedures MOHO can feel like a luxury”“I find it very difficult to integrate my learning into practise due to my current [case management] role”Interim findings: Enthusiasm“This has been a very positive partnership which has helped motivate the team. It has generated a lot of discussion and interest and staff are actively considering how MOHO can be integrated into practise” “it’s an exciting and daunting opportunity. So far I have found it inspiring”“I always come away from the meetings feeling enthusiastic about MOHO and OT!”Interim findings:Evidence for professional worth“We will also be working towards the key messages in Recovering Ordinary Lives in terms of maintaining our focus on occupation and using evidence based outcomes measures – that’s good.”“I am becoming a more skilful, knowledgeable practitioner. The model, its values and associated tools all are providing my work with focus and I feel I hold a new found enthusiasm”Interim findings:Consistency of service across teams and localities“MOHO has the potential to develop consistent and equitable access to, pathways through, responses to and records of OT intervention across the service/ county”“The OT Priority Checklist  has been a very useful tool in helping us to prioritise our referrals.”“It gives the benefit of a shared language and methods regardless of length of time in the job”Interim findings: Increasing levels of confidence“following my initial apprehension I now understand a bit of the basics, it doesn’t feel so overwhelming”“I feel that my confidence as a newly qualified practitioner is developing and that the use of MOHO is doing a great deal towards this as it helps me to feel more certain of my role within the team.”“It has enabled me to evidence my practice [and] feel more confident in discussing my findings with the team”“I feel more sure of my assessment results and initial screening of service users eligible for OT”Interim findings: Stronger professional identity“As a newly appointed band 5 I feel it is helpful in terms of structuring my new role”“I think the team are able to understand the role of the OT better and have clear assessments they can understand”“Using MOHO helps other team members to recognise the value, range and purpose of OT interventions”“stronger professional identity and increased ‘visibility’ in the team.”Interim findings: A refocus on occupation“I have become more efficient at documenting observations focused on occupation without being clouded by other issues that other members of staff can observe and record”“we have been fighting a long battle in being able to focus on our core skills and strengths. MOHO will provide us with the outcome measures to demonstrate our interventions are important”Interim findings: Improved methods for recording and reporting“It has reduced the time that I take to write reports”“I have better, more concise information to give my colleagues”“I’m finding the documentation can be easily understood by other professionals (again adding clarity to process and clarity to role).”Interim findings: An easier role for students to see“As a student I wish I had been given the opportunity to have a practice placement in a Trust that implemented a specific OT model and used the assessment tools associated with it”“students will hopefully find it easier to identify the role of OT and this could aid transition from university to practice”“As a student it was really frustrating to go on placement, somewhere like our CMHT, and find no-one really did or could experience the OT role in terms of using models.”Interim findings: Seen benefits of monthly supervision“It has introduced me to tools I have never used before and never had the confidence or the support to use”“The monthly meetings offer the opportunity to discuss case studies in the context of MOHO”“Monthly supervision meetings provide me with a focus for my monthly goal and ensure I do develop my MOHO skills each month”“Support and learning from others is paramount”Interim findings: Seen benefits for service users“it is without a doubt improving my patient’s journey through WMHPT OT services”“We are better able to provide an equitable service to patients”“”We can provide a more seamless service with continuity of treatment when patients are  moved from one inpatient area to another”Discussion:Time and resources are both concerns as held up within literature (Rappolt 2003; McCluskey 2003; Cameron et al 2005)The use of theory conflicts with the client centred philosophy of occupational therapy (IIott 2002; Welch 2002; Cameron et al 2005; Smith 2006) Despite such concerns we are experiencing enthusiasm and renewal in professional perspectivesRole constraints within CMHT work are proving to be a challenge when trying to implement specialist practices (Hughes 2001). However, CMHT OT’s in our study are finding MOHO supports promotion of their profession-specific skills  (O’Connell & McKay 2010)Discussion: Mainly opinion to date has expressed how implementing an OT model can increase consistency across teams including improved methods for recording and reporting  and value for student experience, we are providing evidence that it canOnly limited studies currently identify how implementation of professional theory provides evidence of increased professional worth and stronger professional identity (Melton et al 2008; Forsyth et al 2005; Wimpenny et al 2006, Wimpenny et al 2010 (forthcoming) our work strengthens this claimROL (COT 2006) identifies importance on refocus of occupationEvidence to date is seeing impact of how theory can prompt and support thisDiscussion: Only limited studies currently provide evidence for seen benefits of professional monthly group reflective supervision as a means of providing support for implementation of professional theory (Wimpenny et al 2006; Quick et al 2007; Boniface et al 2008; Wimpenny et al 2010 forthcoming) our study strengthens such claimsEvidence distinctly lacking in terms of impact of implementing professional theory and capturing service users experiences & perspectives - we are using collaborative methods to do thisSummary & conclusion to date..MOHO is supporting enhanced role identity for the occupational therapists working across the mental health TrustA ‘whole systems approach’ is advocated(Wye & McClenahan 2000; IIott 2002; Chard 2006)Year two of the partnership aims to sustain progress made to date, and build upon this (e.g. training trainers, continued collaborative work with service users and carers) Questions...References Boniface G, Fedden T, Hurst H, Mason M, Phelps C, Reagon C, Waygood S (2008) Using theory to underpin an integrated occupational therapy service through the Canadian model of occupational performance The British Journal of Occupational Therapy Vol 71 (12) 531 – 539 Chard G (2006) Adopting the assessment of motor and process skills into practice: Therapists voices The British Journal of Occupational Therapy Vol 69 (2) 50 – 57 College of Occupational Therapists (2006) Recovering Ordinary Lives: A vision for the next ten years (Core) London: COT Department of Health (2004) The ten essential shared capabilities, London: HMSO Department of Health (2005b) New Ways of Working for Psychiatrists: Enhancing effective person-centred services through new ways of working in multidisciplinary and multi-agency contexts. London: Department of Health. Department of Health (2005) Mental Capacity Act www.dh.gov.uk/en/Deliveringadultsocialcare/MentalCapacity/MentalCapacityAct Accessed 29.05.09 Department of Health (2007) Mental Health Act  www.dh.gov/en/Healthcare/NationalServiceFrameworks/Mentalhealth/dh-089882 Accessed 29.05.09 Department of Health (2007b) Creating Capable Teams Approach (CCTA): Best practice guidance to support new ways of working (NWW) and new roles. London: Department of Health. Department of Health (2009) New Horizons: a shared vision for mental health http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109705 Accessed 17.06.10References Forsyth K, Summerfield Mann, Kielhofner G (2005) Scholarship of Practice: Making occupation-focused, theory-driven and evidence-based practice a reality British Journal of Occupational Therapy Vol 68 (6) 260 - 268 Health Professions Council (2004) Standards of proficiency occupational therapy. London: HPC Hammel J, Finlayson M, Kielhofner G et al (2002) Educating scholars of practice: an approach to preparing tomorrow’s researchers. Occupational Therapy in Healthcare, Vol 15 (1/2) 157 – 176 Hughes J (2001) Occupational Therapy in community mental health teams: A continuing dilemma? Role theory offers an explanation British Journal of Occupational Therapy Vol 64 (1) 34 - 40 IIott I (2002) Challenging the rhetoric and reality: Only an individual and systemic approach will work for evidence-based occupational therapy American Journal of Occupational Therapy Vol 57 (3) 351 – 354 Kielhofner G (2008) A Model of Human Occupation: theory and application 4th Edition. Baltimore MD:  Lippincott Williams and Wilkins McCluskey A (2003) Occupational therapists report a low level of knowledge, skill and involvement in evidence based practice Australian Journal of Occupational Therapy 50, 3 – 12 Melton J, Forsyth K, Freeth D (2009) Using theory in practice. In Duncan E (ed.) Skills for Practice in Occupational Therapy pp 9-23 Edinburgh: Churchill Livingstone Elsevier Nixon J, Creek  J (2006) Towards a theory of practice British Journal of Occupational Therapy Vol 69 (2) 77 – 80 O’Connell J E, McKay E A (2010) Profile, practice and perspectives of occupational therapists in community mental health teams in Ireland British Journal of Occupational Therapy 73 (5) 219 -228References Pettican A, Bryant W (2007) Sustaining a focus on occupation in community mental health practice British Journal of Occupational Therapy, Vol 70 (4) 140 - 146 Quick L, Forsyth K, Melton J (2007) From Graduate to Reflective Practice Scholar British Journal of Occupational Therapy Vol 70 (11) 471 – 474 Richardson B, Higgs J, Abrandt Dahlgren M (2004) Recognising practice epistemology in the health professions In J Higgs, B Richardson, M Abrandt Dahlgren (Eds) Developing Practice Knowledge for Health Professionals Butterworth Heinemann Smith G (2006) The Casson Memorial Lecture 2006: Telling Tales – How stories and narratives co-create change British Journal of Occupational Therapy Vol 69 (7) 304 - 311 Welch A (2002) The challenge of evidence based practice to occupational therapy: a literature review. The Journal of Clinical Governance 10 (4) 169 – 176 Wimpenny K, Forsyth K, Jones C, Evans E, Colley J (2006) Thinking with theory to develop practice British Journal of Occupational Therapy Vol 69 (6) 423 – 428 Wimpenny K, Forsyth K, Jones C, Colley J, Matheson L (2010)  Implementing the Model of Human Occupation across a mental health occupational therapy service:  communities of practice and a participatory change process British Journal of Occupational Therapy(forthcoming) Wye L, McClenahan J (2000) Getting better with evidence – experiences of putting evidence into practice. London: King’s Fund

Practice development: integrating theory to enhance role identity for occupational therapists

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Practice development: integrating theory to enhance role identity for occupational therapists

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